Back and spine surgery can lead to a variety of serious injuries that sometimes amount to medical malpractice. The problems include:
- Unnecessary spine surgery or overly complex spine surgery leading to permanent nerve damage or even paralysis.
- Spinal hematoma (collection of blood) causing pressure on nerves and leading to permanent injury, such as cauda equina syndrome.
One big problem is that money motivates surgeons to talk patients into much bigger and more complex operations than they really need — and then those surgeries result in predictable complications. This is not just a lawyer talking. This news comes from the Journal of the American Medical Association, in an editorial by a leading Stanford orthopedic surgeon, Eugene Carragee, and in a study carried out by a group of doctors at Oregon Health and Science University led by Dr. Richard Deyo.
The Oregon study found that the rate of complex surgeries for back pain in Medicare patients jumped by 15-fold over a recent five-year period, but there was nothing in the patient population — like increasingly complicated back deformities — to justify the increase.
The problem is that the more complex surgeries carry at least double the risk of a bad outcome, according to the Deyo study.
Most back pain that isn’t relieved effectively with medicines or other non-surgical therapies is caused by disk herniation or spinal stenosis. Spinal stenosis is growth of bone near a nerve coming out of the spinal cord which presses on the nerve root and causes pain to radiate down a leg. The vast majority of patients who need back surgery because of spinal stenosis can be benefited from a fairly simple lumbar decompression. This involves removing bone, ligament and facet joint material which is compressing the nerve root.
This is often called a laminectomy, because most of the bone removed is from the lamina that borders the back of the spinal cord. This operation has a high degree of success as it’s been developed over the last 20 years.
According to Dr. Carragee’s editorial, if the patient also has some deformity of the spine — front to back or side to side — the simple lumbar decompression can result in spine instability with increased deformity, so those patients might need a fusion where adjacent vertebrae are fixed together with bone grafts. But even here, simpler techniques get just as good results than more complex procedures that add metal or other instrumentation into the back.
A very small minority of patients, says Dr. Carragee, have spines that are so collapsed and twisted that the spine is unbalanced and tilted forward and the patient has severe pain and poor quality of life. These are the patients who might qualify for the complex surgeries now being done so commonly. Techniques have improved in the last ten years, but the surgeries in these patients still carry a very high complication rate — 30 to 40 percent. And a lot more patients are getting the complex, multi-level surgeries than is warranted by the medical evidence, according to Dr. Carragee and other researchers.
Consumer Reports has rated spinal surgery as No. 1 on a list of overused tests and treatments.
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